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Do patients with iron deficiency without anemia benefit from an endoscopic examination?
Author(s) -
García García de Paredes Ana,
Teruel SánchezVegazo Carlos,
Hernanz Ruiz Nerea,
Ferre Aracil Carlos,
Rodríguez de Santiago Enrique,
Aguilera Castro Lara,
Sierra Morales María,
Albillos Agustín
Publication year - 2017
Publication title -
journal of digestive diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.684
H-Index - 51
eISSN - 1751-2980
pISSN - 1751-2972
DOI - 10.1111/1751-2980.12495
Subject(s) - medicine , colonoscopy , gastroenterology , iron deficiency anemia , odds ratio , anemia , confidence interval , malignancy , hemoglobin , iron deficiency , ferritin , multivariate analysis , etiology , surgery , colorectal cancer , cancer
OBJECTIVE The need for endoscopic investigation in patients with iron deficiency without anemia (ID) is not established. METHODS Data from patients with ID (serum ferritin ≤20 ng/mL, normal hemoglobin) studied with upper and lower endoscopies were retrospectively analyzed. Patients evaluated for iron deficiency anemia (IDA) served as controls, matched by sex and age in the proportion of 2:1. The groups were compared for the presence, type, location and age distribution of endoscopic findings. RESULTS Altogether 109 patients (55% women; mean age 59.6 ± 13.5 years; aged <50 years [27.5%]; 50–69 years [43.1%]; ≥70 years [29.4%]) were included in the ID group and 218 matched controls in the IDA group. Lesions were found in a similar proportion of patients (53.2% in the ID group vs 49.1% in the IDA group, P = 0.48) irrespective of age ( P = 0.92). The colonoscopy diagnostic yield was low in both the ID and IDA subgroups of aged <50 years (6.3% vs 4.2%, P = 0.76). Multivariate analysis revealed a significant relationship between age (odds ratio [OR] 1.04, 95% confidence interval [CI] 1.02–1.06) and male sex (OR 2.28, 95% CI 1.18–4.39) with a positive colonoscopy. Malignancy was significantly less frequent in the ID group (1.8% vs 14.2%, P < 0.05). CONCLUSIONS The prevalence of gastrointestinal lesions in patients with and without anemia was similar but malignancy was eight times less frequent in the ID group. Systematic endoscopic evaluation in patients with ID is therefore questionable.